Ep 173 – Changing the Calculus of Self-Interest in Health Care, with Eric Weaver, Craig Solid, and Andrew Kopolow

We need to change the calculus of self-interest in health care. If the trend of unfettered greed in fee-for-service medicine continues, we will have a bleak future ahead of us. Our industry is on a ventilator, demanding another cigarette. Yet despite its moribund appearance, a few critical vital signs do offer hope. There is an opportunity to find optimism with unifying language and shared virtues to guide health care transformation. By developing a shared vernacular for value-based care, we will be able to have the meaningful conversations to reimagine care delivery. And this new language will be shaped by the evidence from leading exemplars in the value movement.  Amidst the vast wilderness of the healthcare landscape, we can find hope in these green shoots, sprouting with resilience and the promise of a brighter future.

This post-pandemic era is a tremendous opportunity for value creation. Now is the time to have the conversation and be the change we want to be. The elevation of social consciousness related to health equity, transparency, and financial accountability—coupled with industry challenges related to escalating inflationary pressures, workforce shortages, lack of patient access, supply chain disruption, and weaknesses in our public health infrastructure—will provide the catalyst for a new modus operandi in American healthcare.

Joining Eric Weaver on the Race to Value this week are Craig Solid and Andrew Kopolow. Together they recently co-wrote an article published by the American Journal of Medical Quality entitled, “Changing the Calculus of Self-Interest in Health Care.”  In this podcast discussion, they discuss their views about greed in healthcare and what it will take to transform our industry to a more sustainable, value-based model.

Greed has poisoned men’s souls, has barricaded the world with hate, has goose-stepped us into misery and bloodshed. We have developed speed, but we have shut ourselves in. Machinery that gives abundance has left us in want. Our knowledge has made us cynical. Our cleverness, hard and unkind. We think too much and feel too little. More than machinery we need humanity. More than cleverness we need kindness and gentleness. Without these qualities, life will be violent and all will be lost…”  — The Final Speech from “The Great Dictator” (Charlie Chaplin)

Episode Bookmarks:

01:30 Referencing the recently published article, “Changing the Calculus of Self-Interest in Health Care” written by Eric, Craig, and Andrew.

01:45 Eric reads an excerpt from The Final Speech from “The Great Dictator” by Charlie Chaplin.

02:45 How is the greed of fee-for-service healthcare holding us back from our human potential?

03:00 Introduction to Craig Solid, PhD and Andrew Kopolow, MPA MSW CPHQ PMP CLSSMBB FNAHQ.

05:30 Don Berwick’s JAMA article entitled, “Salve Lucrum: The Existential Threat of Greed in US Health Care” which called out our industry for the glorification of profit (Salve Lucrum)

07:30 The difficulty in addressing profit motive through value transformation when “none of us speak the same language” through a shared vernacular in healthcare.

08:30 The emotionality of Dr. Berwick’s article as a recognition of the existential threat of greed in healthcare.

09:15 Hospital closures across the healthcare landscape are seen as just the normal course of business.

09:45 How can we even talk about the quality of care when people can’t even access the care they need?

10:00 The oversimplification of “quality” and “value” is holding us back.

10:45 What is the solution to price gouging of prescription drugs, exploitive market consolidation, upcoding, overpaid executives, lack of transparency, and patient medical bankruptcies?

11:30 The need to align incentives in healthcare so that it does not personify greed as a primary virtue.

12:00 Optimism for socially-conscious healthcare based on Bright Spots and Green Shoots!

12:45 The exemplars of value-based health care (i.e. the Green Shoots) shows us that transformation is NOT mission impossible.

13:15 “Amidst this vast wilderness, hope in healthcare really does take root in the form of green shoots, sprouting with resilience and the promise of a brighter future.”

13:45 High Reliability Organizations are an example of the positive. We need to understand how they operate and maintain solvency.

14:45 Leveraging Green Shoots in the creation of a national playbook strategy for healthcare transformation.

15:00 Acknowledging the complexity of healthcare in recognizing that transformation in not a linear transition.

16:00 “Value and patient-centered care is our North Star. Leading exemplars provide us with an opportunity to cumulatively get to where we need to be.”

16:30 “There is a duality in the future of healthcare. We can stay on our current path or choose one that can actually give us hope through value-based care.”

17:00 ChenMed as a leading example to provide hope in value-based care.

18:00 Other examples of leading innovation include Geisinger, Intermountain, AbsoluteCare, and other leaders in the Race to Value!

18:30 Oak Street Health as another value exemplar, yet Don Berwick questions their level of executive compensation.

19:30 Is there a way to have a capitalist model in healthcare where you can do well by serving the public good?

19:45 Aledade recently purchased the medical debt of their patients to eliminate the friction of healthcare profiteering that leads to poor health outcomes.

20:30 The community benefit of non-profit hospitals is questionable.  Do nonprofit hospitals put profits over patients?

21:00 How do we find our voice for value when most patients have never heard of value-based care and do not know what it means?

23:00 We need to teach people how to think about (and measure) “value” in particular situations.

25:00 The importance of identifying the destination for value (“We are racing ahead to value without really knowing where we are going.”)

27:00 Applying a lens to help us see the hidden opportunities for value (e.g. executive compensation, staff wages, the costs of quality metric reporting).

28:00 We cannot engage in meaningful dialogue until we have a consensus-based and specific definition for value.

29:45 Toxic tribalism in our society hinders progress on major issues (e.g. healthcare reform, mass shootings, climate change, abortion rights, gender-affirming care).

31:30 Understanding the long-term impacts of our actions.  Consensus-based prioritization on sustainability will change the calculus of self-interest.

32:30 There is no path forward without having a better understanding of value.

33:30 High risk for insolvency and diminished care access as key challenges for our value-based future.

34:00 We must be comfortable with subjectivity in defining value and not have that hold us back from having meaningful conversation.

35:00 Starting the conversation with what is in our collective self-interest.

36:30 The importance of shared virtues.

37:30 Optimism for a unifying language to guide healthcare transformation.

38:00 Don’t let the complexity of value prevent us from having the conversation.